Concomitant of Pulmonary Hydatid Cyst and Aspergilloma: A Rare Coinfection

Abstract

The coexistence of cystic echinococcosis (CE) and aspergilloma is rather uncommon. Aspergillus species, saprophytic fungi, can colonize pulmonary cavities that are caused by tuberculosis, sarcoidosis, and CE. Infection by Aspergillus is often occurring in immunosuppressed patients. However, coinfection of aspergilloma with pulmonary hydatid cyst is very unusual, especially in an immunocompetent patient with unruptured cyst. Herein, we report a case of lung hydatid cyst coinfected with Aspergillus in a 42-year-old Iranian man from Southern Iran. Chest X-ray and computed tomography (CT) scan showed a circumscribed cystic lesion in the superior and inferior segment of the lower lobes of right and left lungs that suggests hydatid cyst. Radical surgery (lobectomy) was performed for the patient. Histopathological evaluation reconfirmed the classical laminated layer of hydatid cyst. Moreover, the ectocyst layer of the right lung showed the presence of numerous cluster septate hyphae with acute-angled branching, as seen in the morphology of Aspergillus species. DNA was extracted from the cyst, and the ITS1-5.8s-ITS2 region of the fungal agent was amplified. Sequencing and analysis of seminested PCR product revealed that the isolate has the most similarity with Aspergillus niger. Further attention is recommended to control fungal pathogens during pulmonary hydatidosis. The coexistence of aspergilloma should always be kept in mind for the better management of CE.

Bronchobiliary fistulae as a complication of untreated pulmonary hydatid cyst presenting with bilioptysis: A report of two cases

“…Our center is based among the locations considered endemic for cystic echinococcosis. The disease should be adequately managed before presenting any further complications, such as superinfections or, in our case, fistula 18–21 . Although BBF in many patients is not considered fatal, intraoperative and post‐operative deaths have been reported 5,22 .…”

“…The disease should be adequately managed before presenting any further complications, such as superinfections or, in our case, fistula. 18 , 19 , 20 , 21 Although BBF in many patients is not considered fatal, intraoperative and post‐operative deaths have been reported. 5 , 22 Our patients' outcomes were excellent, and symptoms resolved after surgery.…”

Expansion of Opportunistic Enteric Fungal Pathogens and Occurrence of Gut Inflammation in Human Liver Echinococcosis

“…In line with this notion, Penicillium , which is commonly found in HIV patients ( 28 ), was also significantly overrepresented in this study. Although it remains undetermined whether these pathogenic fungi expansions could cause harmful or or even life-threatening systemic intestinal infections under the situation with HD, increasing cases of concomitant pulmonary or liver echinococcosis and aspergillosis have recently been reported ( 39 – 42 ). As a result, preoperative verification of the presence of local aspergillosis might be practically necessary.…”

Hospital-based retrospective analysis of 224 surgical cases of lung hydatid cyst from southern Iran

“…Hydatid cysts are usually detected as multiple circumscribed oval or solitary masses in radiological imaging [ 6 ]. Pneumothorax, suppuration, rupture, and secondary infection are considered as pulmonary hydatid cysts complications [ 6 , 9 – 15 ]. Serological diagnosis may help in the diagnosis of pulmonary hydatid cyst [ 16 – 18 ].…”